In January 2018, the Centers for Medicare and Medicaid (CMS) clarified their position on skilled nursing and therapy services. In the past, those services were limited according to time or obtaining maximum benefit. After a lawsuit by Jimmo vs. Seibelius, CMS now says that there is no limit on those services as long as a qualified health care provider certifies the therapy is medically necessary.
The significance of the clarification of services will be monumental in the lives of those living with disabilities. Now patients can get all the therapy they need without being told they “maxed their benefits” or “you are at the end because you are not improving”. Many patients live years with disabling conditions that limit their physical abilities. Therapy improves the ability to speak, eat, walk, and dress. The results have a positive impact on their overall quality of life, mental health and independence. It is well known that therapy is not a “once and done” event. Strength wanes, swallowing becomes difficult and putting a pair of pants on can be a daunting task when fingers can’t grip. Periodic therapy sessions can help prevent disabilities from worsening.
It is possible that with more access to therapy patients will experience fewer falls, injuries related to weakness, and less depression. Decreasing the frequency of falls alone can have huge ramifications. In particular, fewer falls can mean fewer hip fractures, a common reason why people become wheelchair bound.
There is much that needs to be learned about how the new rules will be implemented. There will be many questions, particularly about out-of-pocket expenses. But this is definitely a move in the right direction. If implemented correctly, we may actually see more people on their feet and fewer ones in wheelchairs. The hope is to see more people living in independence rather than dependence.